From interactive computer programs
to group sing-alongs, Children's Hospital Boston's Communication
Disorders Center is finding new and exciting ways to help children with
communication difficulties learn and interact.

Eight-year-old Brian Lundy sits engrossed in the images and sounds on
his computer. He giggles and smiles, swaying to the music and repeating
each word after it's spoken by the animated character on the screen.
Brian's mother, Ann, sits a few feet behind him in awe. "Brian has zero
attention span," she says, making the zero sign with her hand. "None
whatsoever."

What's captivating her son is Puddingstone Place, a new virtual environment developed by Howard Shane, PhD, director of the Communication Disorders Center
(CDC) at Children's Hospital Boston. The software is aimed at helping
children like Brian, who have communication disorders, improve their
language and communication skills.

Children with a variety of developmental
disorders—from autism spectrum disorders to Fragile-X syndrome (a
genetic condition causing delays in speech, language and motor skills
development)—have difficulty mastering language and communication
concepts. Brian, for example, has a Landau-Kleffner syndrome variant, a
rare epileptic disorder characterized by loss of language, and autistic
and obsessive/compulsive behaviors, including an extreme lack of focus
and some auditory challenges.

"At first, Brian didn't have any spoken
language at all; he only communicated through sign language," says Ann.
"But he's made tremendous progress in the past few years, moving to a
combination of pictures and sign, then voice and sign and now he mostly
uses voice."

Brian attends a regular elementary school
where he takes part in an aggressive speech and language program,
working with therapists during seven separate daily sessions that
concentrate on various communication skills. But he still has
difficulty with certain aspects of language, like word retrieval.
"He'll often describe the action an object makes, rather than its
actual name," says Ann. "For example, he might refer to a shovel as a
'digger.' And other times, he won't be able to come up with any word at
all."

That's why an interactive software program
like Puddingstone Place could really benefit Brian. An engaging
animated character named "Champ" guides children through a virtual
house comprised of photo-realistic scenes of various rooms, all of
which contain common household objects. When a child clicks on
something, its name pops up on screen and is spoken aloud by the
computer. And some items, like the toaster in the kitchen and the
hammer in the garage, can be double-clicked to initiate the action and
sounds the object makes.

The proof is in the pudding
Through clinical observation and parent interviews, Shane and his team
found that children with developmental disorders are particularly
engaged by visuals in the form of electronic screen media—TV, video,
computers and video games. His research also revealed that they respond
best to animated onscreen characters.

"We've long known that children with developmental disorders respond best when things are presented visually," says Janice Ware, PhD,
associate director of Children's Developmental Medicine Center. "With
computers so accessible to children today, a highly sophisticated
computer program like Puddingstone Place could definitely be used to
supplement speech/language and behavioral programs."

The software is designed to be used with a
parent, teacher or clinician, since many children who have trouble with
language also have a hard time with social communication. "Adults who
are working with the children can capitalize on their attention and
interest and begin to work with them on language and communication
skills," says Shane.

To address Brian's word retrieval
difficulty, Shane sets the program to give partial auditory cues for
each word, allowing Brian to come up with the full word on his own. In
the kitchen Brian is given the cue "re" after which he immediately
says, "refrigerator." Interestingly, when Brian returns to the kitchen
later, he says "refrigerator" without the auditory cue.

"The idea is that the child will learn
the name of an object and then the visual connection to what it is and
what it does," says Shane. "Our hope is that, ultimately, he can
transfer these skills to the real world."

Brian also has a problem
recognizing and interpreting the sounds around him, which makes it
tough for him to follow directions. "When directions are spoken to
Brian in simple terms, he's generally able to understand them,"
explains Ann. "But as they get more complex, it gets really challenging
for him."

So Shane guides him to the
playroom for the "Dress Up Champ" game, which asks Brian to make
choices about what Champ will wear—a baseball uniform, a firefighter
suit, a cowboy outfit or some combination of the three. He first
selects the firefighter suit, and when he mistakenly tries to place the
pants where the shirt belongs, Champ tells him that his pants don't go
there. Brian giggles and places them in the right spot.

Developed
by Children���s Hospital Boston���s Communication Disorders Center,
Puddingstone Place is an interactive software program that helps
children with a variety of communication disorders learn language and
social communication skills.

The "Dress Up
Champ" game (at left) is one of three activities found in Puddingstone
Place���s playroom. It allows children to select the clothes Champ will
wear and provides positive reinforcement when the children put the
correct item of clothing in the right place.

"The
Dress Up Champ game helps kids with a lot of different skills," says
Shane. "For example, it's asking Brian to follow directions in a
sequence, which he sometimes has trouble with, using visual cues—one of
his strengths and verbal cues that hopefully he can learn to connect
with the visuals." Brian likes the game so much that he plays it all
the way through four times, excitedly repeating each item of clothing
and dressing up Champ.

"Brian always responds
very well to computers," says Ann. "This is definitely something I can
see us using to reinforce the language and communication work he's
doing in school and to help build his vocabulary. It's also a fun and
highly motivating activity for him that holds his attention to the
point where he doesn't realize it's educational."

Shane hopes to make
Puddingstone Place commercially available in the coming year.
Meanwhile, the CDC team is always brainstorming new and different ways
to help children communicate. "Our hope is that by observing trends and
patterns, we'll be able to develop new and more effective technologies
for children with all communication disorders."

The sound of learning
Dorry Brown sits in front of a group of attentive 4- and 5-year-olds
with various communication disorders. She holds up a picture of Champ
with strips of Velcro strategically placed all over his body, and leads
the children in the "Sticky Bubblegum Song." The song prompts the
children, one by one, to indicate where they'd like to place the bubble
gum on Champ. On his nose? His belly?

Clare
Dalton now uses music to engage Eric in many common household tasks,
like preparing a fruit salad with his sister Courtney.

It's
a fun, silly game that the kids enjoy immensely—but there's more at
play here than a simple sing-along. As coordinator of Children's Group
Language Therapy Program in the CDC, Brown uses this and other songs to
encourage language and social communication skills in children with
developmental disorders. "We know that music can support social and
cognitive growth in children," says Brown, "particularly those with
developmental differences, who often have trouble interacting and
learning in typical educational environments."

Music has certainly helped 7-year-old Eric Dalton, who has Fragile X syndrome.

"When
Eric was little, he only communicated in simple, single words and never
sang or combined them," says his mother, Clare. "He basically had no
expressive language."

Clare's pediatrician
referred Eric to the CDC, where he was first introduced to Brown. "Eric
was in this phase where he would repeat an action over and over when he
was nervous or uncomfortable," says Clare. "At that time, it was
opening and closing doors. So when we met Dorry, sure enough, he
started opening and closing the door to her office."

What happened next would
forever remain with Clare, and help her through a lot of difficult
times with her son. "Dorry knelt down beside Eric and asked if she
could have a turn opening and closing the door when he was finished,"
she recalls. "The look on his face was pure shock���he'd always been
told to stop these types of behaviors. I could see that Dorry really
connected with him, and I began to cry." After a few more bouts of
opening and closing the door, Eric gave Brown a turn, and the two have
maintained a close connection ever since.

Singing is participating
Eric has participated in all three language therapy groups that Brown
facilitates. The groups meet twice a week, consist of five children
each and are arranged by age (2- and 3-year-olds, 3- and 4-year-olds,
and 4- and 5-year-olds). Each child is assigned a Speech Pathology
graduate student who works with him one-on-one and during group
activities. Brown oversees all interactions and also leads "circle
time," when the group comes together to sing.

"That's when Dorry really
works her magic," says Ware. "Her music captures and maintains the
children's attention and provides built-in opportunities for repetition
that are so critical to reinforcing language and communication
learning."

Dorry
Brown leads circle time during one of her group language therapy
sessions. She uses the cardboard cutout of Champ on her right to
reinforce the words of the songs.

The
Sticky Bubblegum Song is a perfect example. It incorporates the names
and locations of body parts, repeating them during every verse of the
song. And that's not all. Through the years, Brown's musical repertoire
has expanded to include visual supports, like the cut-out of Champ.
"Music by itself captures and maintains children's attention," says
Brown. "But when the lyrics are paired with actions and pictures, it
encourages their participation."

Brown makes cassette tapes
of all her songs for parents to use with their children outside of her
group. "Dorry's tapes have made such a difference in our lives," says
Clare. "We'd get in the car after therapy and sing all the way home,
when we set the table or brushed our teeth we'd sing���it was a whole
new way for me to connect with Eric."

Brown's approach to music
has grown so popular through her classes and by word of mouth that she
is now working to bring it to the general public through "Learning
Together with Music," a CD that encompasses all of her tricks of the
trade.

The CD is targeted at
educators, parents and clinicians. It explores how to incorporate music
into a child's life, identifies and explains the learning goals of each
song and includes video clips from one of Brown's circle times. It also
includes printable graphics and two interactive software games, which
were developed from circle time songs. Champ appears in the Sticky
Bubblegum game on both the Puddingstone Place and Learning Together
with Music CDs.

"Dorry's program presents
language therapy in such a joyful way—no words can describe it," says
Clare. "It really opened my eyes to a whole new level of understanding
with Eric. Dorry was the first person to show that my son's condition
was okay—I didn't have to fix him or try to bring him up to my level."

To support the Communication Disorders Center, contact Brandt Henderson in the
Children's Hospital Trust at (617) 355-5342 or brandt.henderson@chtrust.org.

All information provided on diagnosis and therapy
reflects the care environment of Children's Hospital Boston and
related
physician practices. It is not a substitute for the professional
judgment of a qualified heath care provider based upon actual
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should not be construed as medical advice for any particular
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